Here are some frequently asked questions about Endodontic treatment:

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1 Here are some frequently asked questions about Endodontic treatment: What is an "Endodontist"? Endodontists are dentists who specialize in treating the soft inner tissue of your tooth's roots. After they complete dental school, they attend another dental school program for two or three more years. This program is called an advanced specialty education program. They study only endodontic treatment and learn advanced techniques so they can give you the very best care. Endodontists are specialists. In their offices, they perform only endodontic procedures, both routine and complex. They are also experienced at finding the cause of oral and facial pain that is difficult to diagnose. Why do I need to be referred to an endodontist? Beyond a DDS degree, an endodontist has a minimum of two additional years of advanced training specific to treatment of the pulp and surrounding tissues of the tooth. An endodontist performs routine as well as difficult and very complex procedures. An endodontist is able to devote themselves to specific technologies and continuing education with the goal of optimizing your endodontic care. Why is there a need for endodontic treatment? Sometimes the pulp inside your tooth becomes inflamed or infected. This can be caused by deep decay, repeated dental procedures on the tooth, a crack or chip in the tooth, or a blow to the tooth. What are the signs of needing endodontic treatment? Signs to look for include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. But sometimes, there are no symptoms. How does endodontic treatment save the tooth? The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the canals 1 / 8

2 inside the tooth, then fills and seals the space. Afterwards, you return to your general dentist, who will place a crown (if it does not already have a crown) or other restoration on the tooth to protect it and restore it to full function. Is a root canal painful? Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure. For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist's instructions carefully. Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your endodontist. What about infection? We adhere to the most rigorous standards of infection control advocated by OSHA, the Centers for Disease Control and the American Dental Association. We utilize autoclave sterilization and barrier techniques to eliminate risk of infection. We also use a self-contained water system to eliminate contamination. Will the tooth need any special care or additional treatment? You should not chew or bite on the treated tooth until you have had it restored by your general dentist to prevent breaking the tooth (if your tooth already has a crown on it, avoid chewing on it for a couple of weeks). Otherwise, just practice good oral hygiene - brushing, flossing and regular checkups and cleanings. What happens after treatment? It is our goal to partner with your referring dentist to provide you with optimal dental treatment. When your root canal therapy has been completed, a final restoration will be necessary and is most often performed by your referring dentist. We are able to assist you in making the appointment with your dentist, who will recommend what type of restoration is necessary to protect your tooth. A report of your treatment and your final radiograph will also be sent to your dentist. What causes an endodontically treated tooth to need additional treatment? 2 / 8

3 New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, your endodontist may discover very narrow or curved canals that could not be treated during the initial procedure. Sometimes a treated tooth may need endodontic surgery to be saved. What is endodontic surgery? The most common endodontic surgical procedure is an apicoectomy or root-end resection. It is used to relieve inflammation or infection in the bony area around the end of your tooth that continues after endodontic treament. The endodontist opens the gum tissue and removes the infected tissue and may remove the very end of the root. A small filling may be placed to seal the root canal. Endodontists use local anesthetics, like those used when you have a cavity filled. Most patients return to their normal activities the next day. Why do I need another endodontic procedure? As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons: - Narrow or curved canals could not be treated during the initial procedure. - Complicated canal anatomy went undetected in the first procedure. - The placement of the crown or other restoration was delayed following the endodontic treatment. - The restoration did not prevent salivary contamination to the inside of the tooth. - Failure of the body's immune system to resolve the infection. In other cases, a new problem can jeopardize a tooth that was successfully treated. For example: - New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth. - A loose, cracked or broken crown or filling can expose the tooth to new infection. - A tooth sustains a fracture. Is re-treatment the best choice for me? Whenever possible, it is best to save your natural tooth. Re-treated teeth can function well for years, even for a lifetime. Advances in technology are constantly changing the way root canal 3 / 8

4 treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with re-treatment. As with any dental or medical procedure, there are no guarantees. Dr. Crisp will discuss your options and the chances of success before beginning re-treatment. What are the alternatives to endodontic re-treatment and/or endodontic surgery? The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than re-treatment and restoration of the natural tooth. No matter how effective tooth replacements are-nothing is a good as your own natural tooth. You've already made an investment in saving your tooth. The payoff for choosing re-treatment could be a healthy, functioning natural tooth for many years to come. Signs & Symptoms commonly experienced by patients with endodontic needs: - Prolonged sensitivity to hot and cold - Tenderness to biting - Discoloration of the tooth - Swelling - Pain in the jaw or ear - A pimple (Fistula) on the gum Can all teeth be treated Endodontically? Most teeth can be treated. Occasionally, a tooth can't be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn't have adequate bone support, or the tooth is severely damaged by decay and cannot be properly restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth. I'm worried about x-rays, should I be? No. While several radiographs (X-rays) may be necessary during your treatment, we use an advanced non-film computerized system called digital radiography that produces radiation levels up to 90 % less than those of conventional dental x-ray equipment. With this technology, you will also be able to view your radiograph on a computer screen prior to your treatment. 4 / 8

5 What new technologies are being used? Digital Radiography: X-ray procedures are an essential part of quality endodontic therapy. Our office utilizes an advanced non-film dental imaging system known as CDR (computed dental radiography). The already low radiation required required for dental radiographs is further reduced by over 80% compared to conventional D speed film. Using this system, an electronic sensor produces computerized radiographs which appear instantly on a chair side computer screen. These images can then be optimized, printed, archived indefinitely and sent to your dentist. Nickel-Titanium Instruments: Cleaning and shaping of the root canal is aided by the use of metal instruments made of a unique alloy of nickel-titanium. We use both hand and rotary instruments along with a liquid antimicrobial agent to help remove bacteria and tissue. Apex (Root Tip) Locators: Apex locators are electronic devices which are employed to more accurately determine the length of the tooth root. Apex locators help ensure the diseased tissue is removed from the entire root and may reduce the need for additional radiographs. Mineral Trioxide Aggregate (MTA): A hydrophilic ceramic material that is a relatively new advancement in endodontic treatment. We use MTA for a variety of root repairs (resorption repairs, root perforation repairs). It is used in situations with young patients (pulp capping in apexogenesis, an apical plug in apexification). MTA is also used as a root end filling during endodontic microsurgery. Current literature supports its use as a biocompatible material with excellent resistance to leakage. 5 / 8

6 Waterlase Laser: By their very nature, lasers can be used to reduce discomfort during and after root canal treatment. They also let Dr. Crisp work more quickly and with unprecedented accuracy. Lasers disinfect areas better, approaching sterilization, and are more effective than the standard of sodium hypochlorite. Lasers even reduce bleeding and promote healing. With lasers, Dr. Crisp can remove the layer of tiny debris that commonly remains following "traditional" root canal therapy... and that may lead to the need for endodontic re-treatment or surgery. Some other uses are: - Gingivectomy- Dr. Crisp uses lasers to remove excessive gum tissue in order to best see and treat an infected tooth. - Crown extensions - Dr. Crisp can "extend the tooth crown" by using the laser to remove gum and bone tissue to expose more of the tooth. - Faster, easier apical surgery- Lasers are used to remove infected root end and can be done with greater control, smoother incisions, less bleeding, less tissue damage and less postoperative inflammation and pain. Why Waterlase Laser Dentistry? Dr. Crisp has chosen to invest in Waterlase to provide you with the highest standard of dental care. Here are some of the benefits you will experience with Waterlase laser dentistry. - INCREASED COMFORT Heat, vibration and pressure are the primary causes of pain associated with the use of the traditional dental drill. Since cutting teeth and gums with the Waterlase does not generate heat, vibration or pressure, many dental procedures can be performed with fewer shots, less need for anesthesia, less use of the high speed drill! - ACCURACY AND PRECISION Waterlase removes tooth enamel decay (the hardest substance in the body), bone and gum tissue precisely while leaving surrounding areas unaffected. This conserves and allows your dentist to preserve more of the healthy tooth structure. 6 / 8

7 - REDUCED TRAUMA High speed drills can cause hairline cracks and fractures in the teeth that eventually lead to future dental problems. Waterlase reduces damage to healthy portions of the tooth and minimizes trauma. - IMPROVED CAVITY FILLINGS Waterlase cavity preparations can increase bond strength of tooth-colored restoration resulting in longer lasting fillings. - LESS BLEEDING AND SWELLING Due to its conservative, gentle cutting action and coagulating capabilities, the Waterlase performs many procedures on the gums with little or no bleeding and less post-op swelling. Is Waterlase safe? Lasers have long been the standard of care in medicine for many surgical and cosmetic procedures such as LASIK, wrinkle removal, hair removal and many others. The Waterlase was approved by the US FDA for hard tissue procedures in 1998 and since has been cleared for numerous additional dental procedures. Thousands of dentists around the world have performed millions of procedures with less need for shots, anesthesia, drills and numb lips. You, the dentist, and the assistant will wear special laser safety glasses when the laser is being used. How does it work? Waterlase uses a patented technology combining laser energy and a spray of water, a process called HydroPhotonics, to perform a wide range of dental procedures on teeth, gum and bone more comfortably. What does it do? Waterlase was first cleared by the Food and Drug Administration (FDA) to cut tooth structure in 1998 and since that time has received numerous additional clearances from the FDA for a wide range of procedures on teeth, bone and gum tissue. 7 / 8

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